LYMPHOPROLIFERATIVE DISORDERS AFTER ORGAN-TRANSPLANTATION - A REPORT OF 24 CASES OBSERVED IN A SINGLE-CENTER

Purpose: Organ recipients are at a high risk of post-transplant lympho proliferative disorders (PTLDs) as a complication of immunosuppressive therapy. We report the incidence, clinical presentation, pathologic f indings, treatment, and outcome for 24 cases of PTLD observed at our i nstitution. Patients and Methods: Twenty-four (1.7%) of 1,385 organ tr ansplant recipients developed PTLDs. Dosages of immunosuppressive drug s were reduced in 19 patients. Treatment consisted of anti-B-cell mono clonal antibodies (12 patients), and/or chemotherapy (eight patients), or surgery (two patients). Results: the median time between grafting and the onset of PTLD was 210 days. Tumors were classified as monomorp hic and polymorphic in nine and 15 cases, respectively. Three of 24 ca ses were of T-cell origin. Genotypic studies confirmed the monoclonali ty of the tumors in 11 cases among 14 PTLDs tested. Epstein-Barr virus (EBV) infection was associated with 70% of B-cell PTLDs tested. The o verall median survival duration was 5 months. Ten patients are alive a nd disease-free with a median follow-up time of 37 months; most were t reated with anti-B-cell antibodies. Two other patients died in complet e remission of unrelated causes at 33 and 38 months. Conclusion: Anti- B-cell monoclonal antibody therapy seems be effective in PTLD, even in monoclonal B-cell forms, but other approaches will be necessary to im prove survival further. J Clin Oncol 13:961-968. (C) 1995 by American Society of Clinical Oncology.